Therefore we do not fully concur with the statements of the Bushby et al. papers that '… the pharmacological mainstay of neuromuscular management in DMD is the use of glucocorticoids,' and 'Recent evidence from clinical trials supports the treatment of cardiomyopathy associated with DMD before signs of abnormal functioning. Further studies are awaited to allow firm recommendations to be made.' Instead, we believe that the current issue is: what is the optimal age to start angiotensin-converting-enzyme inhibitors? In vivo and in vitro studies support this hypothesis that this class of molecules not only acts on myocardium but also in increasing peripheral muscles function (including respiratory muscles) through their anti-inflammatory and anti-fibrotic properties. As both of these mechanisms are involved in the pathogenicity of dystrophin deficiency, therapeutic trials are currently under way to answer this important question.
Most common diagnoses in travellers to South Asia were gastroenteritis (12/43,27%) and non-specific viral illnesses (11/43,26%). Conclusions Almost half of patients presented with a diagnosable infection, using investigations relevant to their clinical presentation.Malaria cases were identified only in travellers to Africa and West Asia. A greater proportion of gastroenteritis was identified in patients traveling to South Asia, in which stool and blood cultures identified the most positive investigations.In febrile travellers returning from Asia and Africa, we would advocate a low threshold for a chest radiograph, parasite blood film, stool and blood culture being performed, due to high potential risk of infection and varied symptoms on presentation.
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